Bill-payment form.



H. F. PRICE.

BILL PAYMENT FORM.

APPLICATION msn MAY3|, 191e.

Patented Sept. 18, 1917.

2 SHEETS-SHEET l.

.h bbk. Stank \NG\ H.y F. PRCE.

BILL PAYMENT FORM. APPLICATION men MAval. |916.

Patented Sept. 18, 191?.

2 SHEETS-SHEET 2.

N www Mice/66625.'

demand `they addressed to and-acting as fran sra'rns rarnnfr ernten. i

HENRY F. PRICE, OF RIVERSIDE, CONNECTICUT, ASSIGNOR, BY MESNE ASSIGNMENTS, TO THE BUDGET CHEQUE CORPORATION, OF CHICAGO, ILLINOIS, A CORPORATION OF ILLINOIS. Y

BILL-PAYMENT FORM.

Application led May 31, 1916.

To all whom t may concern:

Be it known that I, HENRY F. Prion, a vcitizen of the `United States, residing at Riverside, in the county of Faireld and State of Connecticut, have invented certain new and useful Improvements in Bill-Payment Forms, of which the following is a specification.

My invention relates to improvements in the art of banking and has particular reference to novel means for disbursing money in favor of a plurality ofv persons or accounts.

Ithas become common practice for individuals and corporations to receive material or supplies on credit, payment therefor being made at regular intervals, say once each month. At that-time it becomes necessary to disburse a relatively large sum of money by means of'checks, vouchersor drafts, each of these devices used for the payment of money requiring the expenditure of considerable time with the chance of error due to the large number thereof.

It is also true that particularly in-small communities -many or all of the individualsv or. firms interestedy in the transactions referred to have accounts atd the same bank. An object there-fore in the present invention is to reduce the labor and expense of disbursing moneys by consolidating the `accounts and giving to the bank or depository a bill ayment check for the aggregate sum with instructions to thel depository'toL distribute the same by crediting certain designated sums to the accounts Vof certain designated firms or individuals. v

It will ibe understood, of course, that even though thedesignated payees may not have an account at the depository, the said payees may be'duly notified by the bank that upon will receive cash or-exchange for the-.amount designated to be paid to said payees. l. f

My invention ycontemplates vin `elfect the rovision ofY a device in the form of a chec an order on a depositoryito .make Vdesignated payments tothe orderl of a plurality ofy payees in settlement riodic bills. l 1- v y A further feature of the invention-is the utilization-of a carbon'duplicate ofthe written portionA of the check for retention by the drawer in lieu of the usualstu'b, this carbon imprint-appearing on the face :of an envelop Specification of Letters Patent.

`scription are to be taken sections being Patented Sept. 18, 191'?.

serial no. 100,766.

forming a detachable portion of the check and within which may be preserved the several bills in payment for which the check is drawn,thus providing a receptacle for monthly bills on the face of which is a carbon imprint of the items embraced in the check by which they were paid.

In order that the invention and the manner of its utilization may stood a preferred embodiment of the same is set forth in the accompanying drawings and in the following description based thereon. Obviously the form of the check and the matter imprinted thereon will vary to suit `of the bank issuing such form, wherefore it will be understood that the drawing and dein an illustrative rather than in I an unnecessarily limiting sense. lIn the drawingsv Y Figure 1 is a face view of a detached check portion adapted for transmission to the bank;

Fig. 2 is a similar view of the check portion` or duplicate adapted for retention by the drawer;

Fig. 3, showing the two check portions assembled with the carbon-sheet; and Fig. 4t is alongitudinal section through the check or other bill payment form.

It will be observed that in the illustration given the bill payment form is inthe nature of a bank check and comprises a plurality of sections, thel section 11 (shownin Fig. 1) consisting of a plurality of parts, one bearing thereon the naine of the bank and containing instructions to the bank to charge .a total amount to the account of the drawer and to distribute to a plurality of parties specified individual amounts the sum ofwhich equals the said total amount while another part of the same section comprises spaces for the names of parties to whom disbursements are to be made yand for the insertion of the individual amounts to be dis` lbursed to said parties, while the section 12,

to be retained by the depositor or drawer comprises space for a duplicate record of the names of said payees and of the individual amounts to be distributed to them, the two separately `joined along a weakened or perforated line 13, along which line the section 11 is normally folded over on top of the section-12 in order thatthe v'naines of the payees and amounts appearing in the space on section 12 may be imprinted by means of a carbon sheet 14 placed between the two sections.

Obviously the number of acco-unts paid by the onel check may be-large or small, the print of thecheck forinula'addressed to the bank may be varied to suit the choice of the particular bank issuing the check, the inclusion of postage, as shown in the illus-y tration may be waived, and other non-essentials modified within a wide range vwithout departure fro-m or a sacrifice of the advantages characteristic .of the invention.

The duplicate check section may contain suitable directional matter as tothe filing therein of the bills, such asindicated in the drawings, or obviously the printed matter may be a duplicate of the check form or it may loe-omitted entirely, the essential feature of the same being the :space thereon, corresponding to that on the 'check Vand adapted for registry therewith, for an imprint of the names and addresses of the payees and the amounts of paid, which matter may be written directly thereon or,'1: referably, imprinted by means y of the carbon'paper at the time of writing check section 11 along the check.

The check section 12, adapted for reten tion by the drawer, is preferably made in the formiof an :envelop with the back cover 12g, the same being made` of a blank suitably folded and marginally secured as indi` cated in the drawing along the overlapping A edges, this envelop serving as a receptacle for the statements or bills settled by means of the check.

In use, the Adrawer having before him several vmonthly statements or bills to be set tled, takes `one ofthe bill. payment forms and placing the carbon sheet 14 in position between'the check sections 11 and 12, fills out the check with the names and addresses of his creditors and the respective amounts duethem las shown by their individual bills, dating the check and signing the same in the spaces provided. l He includes twocents each for postage if such'is required by the bank and adds the item-s to, make the total amount Vof .the check. He then detaches the `the weakened line 13 and mails it .to the bank, placing .the bills 'Of the envelopA .check section 12 containing comprising' spaces for the signature' of the depositor, the. names yfor the. signature ,ot

thus disposed of; in `the envelopgand files it away for future reference. The several bills, .their `amounts, kdates and manner. of settlement appearing at a glance on the face `drawer as'my directed.

Iclaimz v m 1. A bank Vcheck having thereon a space the drawer and. comthe severall sums :nailed Ipayees prising a plurality of parts, one .part bearing thereon the name of a bank and containing instructions to the bank to charge a total amount to the account of the drawer and to distribute to a plurality of parties specified' individual amounts, the sum of which equals said total amount, and another part of said check comprising spaces for the names of said parties' to whom amounts are to be distributed. for the insertion of indi vidual amounts to. be distributed to said parties, and a third part formed as a recepta-v cle for documents showing' the individual Aaccounts tov which payments of the saidV individual amounts may be applied.

K 2. A bank check having thereon a' space for the signature ofV the drawer and .comprising a plurality of sections, one section bearing thereon thev name of a bank and containing instructions to theV bank to charge a total amount tothe account of the drawer, and to distribute to a plurality of parties specied individual amounts, 'the sum `of which equals saidtotal amount, av second section comprising spaces forfthe names of said. parties to4 whom distributions are toy be made. and for the insertion ofthe individual amounts to be distributed to said parties, a third section to, be retained by the drawer comprising a receptacle for the bills paid by the. said check andV spaces for duplicate records ofthe names. of said plurality of parties and; of the Vindividual :amounts tobe distributed to. them.

Yinstructions to.- make vdisbursementsl from such deposit-'and having spaces.- forthe -sig- 105 nature of the depositor and. for the'insertion of' a total amount equal to Athe sum. ofthe amounts to. be disbursed, another-part comprising spaces. for the names of :parties Vto whom disbursements ar to be madeand 110 for the insertion of the. individual lamounts to be disbursed toy said panties, and. Va third part to. be lretained by the depositor, comprising inv combination. 'a from the. said pluralityv of ,p forrecords ofthenames ofy theplurality of parties and ofthe individual 'amounts' to be disbursed tothem. Y 4. A device for usein disbursing to a. plubank, consisting incombination ofY aform of the .'payees, the. individual amounts:V to, be disbursed to` said payees, and the total of said' individual 125 amounts, and having thereon an order on the said bank to payv the designated ind-ividual amounts. to. the respectifvel'yfl desigand to chargeA the said. total amount to the account of, said depositor, and l=30 of a receptacle adapted to contain bills from the said payees and having spaces for memoranda of the said individual amounts as applied to the said bills.

5. A bill payment form comprising a plurality of separable sections, one section bearing the name of the bank and containing instructions to the bank to remit to specified parties designated amounts aggregating a designated total sum for the account of the drawer and also including spaces for writing in the .dat-e, the name of the payees and the amounts,- and the signature of the drawer, and another section having spaces for dates, signature and names of payees and amounts as appearing on the first section, the irst section adapted for transmission lto the bank and the second section adapted for retention by the drawer and being formed as an envelop receptacle for the bills paid by means of the first section.

6. A bill payment form comprising a plurality of separable sections, one section bearing the name of the bank'and containing instructions to the bank to remit to specified parties designated amounts aggregating a Copies ofA this' patent may be obtained for designated five cents each, by addressing the Washington, D. C.

total sum for the account of the drawer and also including spaces for writing in the date, the name of the payees an the amounts, and the signature o drawer, and another underlying section having spaces registering with the spaces for date, signature and names of payees and amounts as appearing on the overlying section, and a .carb the first and second section by means o which to imprint upon the second section the matter written in upon the first section, the first section adapted for transmission to the bank and the second section for retention by the drawer, the second section formed as an envelop receptacle for the bills paid by means of the rst section.

In witness whereof I have hereunto signed my name inthe presence of two subscribing witnesses numbering and initialing the sheets to which this signature applies.

HENRY F. PRICE.

Witnesses WM. H

BRETTMAN, A. B. STANTON.

Commissioner of Patents,

f theon sheet disposed between 

